Does socio-economic inequality exist in micro-nutrients supplementation among children aged 6–59 months in India? Evidence from National Family Health Survey 2005–06 and 2015–16

Abstract Background Globally, about 25% of children suffer from subclinical vitamin A deficiency (VAD), and approximately 300 million children globally had anemia as per 2011 estimates. Micronutrient deficiencies are generally referred to as “hidden hunger” because these deficiencies developed gradually. The present study determines the socio-economic inequalities in vitamin A supplementation (VAS) and Iron supplementation (IS) among children aged 6–59 months in India and to estimate the change in the percent contribution of different socio-economic correlates for such inequality from 2005 to 06 to 2015–16. Methods Data from National Family Health Survey (NFHS) 2005–06 and 2015–16 was used for the analysis. Bivariate analysis and logistic regression analysis was used to carve out the results. Moreover, Wagstaff decomposition analysis was used to find the factors which contributed to explain socio-economic status-related inequality among children in India. Results It was revealed that the percentage of children who do not receive vitamin A supplementation was reduced from 85.5% to 42.1%, whereas in the case of IS, the percentage reduced from 95.3% to 73.9% from 2005-06 to 2015–16 respectively. The child’s age, mother’s educational status, birth order, breastfeeding status, place of residence and empowered action group (EAG) status of states were the factors that were significantly associated with vitamin A supplementation and iron supplementation among children in India. Moreover, it was found the children who do not receive vitamin A supplementation and iron supplementation got more concentrated among lower socio-economic strata. A major contribution for explaining the gap for socio-economic status (SES) related inequality was explained by mother’s educational status, household wealth status, and empowered action group status of states for both vitamin A supplementation and iron supplementation among children aged 6–59 months in India. Conclusion Schemes like the Integrated Child Development Scheme (ICDS) would play a significant role in reducing the socio-economic status-related gap for micro-nutrient supplementation among children in India. Proper implementation of ICDS will be enough for reducing the gap between rich and poor children regarding micro-nutrient supplementation.

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Uptake of routine vitamin A supplementation for children in Humbo district, southern Ethiopia: community-based cross-sectional study

BMC Public Health ◽

10.1186/s12889-020-09617-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Getnet Kassa ◽

Addisalem Mesfin ◽

Samson Gebremedhin

Keyword(s):

Preschool Children ◽

Vitamin A ◽

Vitamin A Deficiency ◽

Economic Status ◽

Cross Sectional Study ◽

Southern Ethiopia ◽

Sectional Study ◽

Cross Sectional ◽

Vitamin A Supplementation ◽

Socio Economic Status

Abstract Background In low- and middle-income countries routine vitamin A supplementation (VAS) is a key strategy for reducing vitamin A deficiency and mortality and morbidity of preschool children. However, in Ethiopia, there is paucity of evidence regarding the level and determinants of the uptake of the supplement. This study was designed to assess the coverage and predictors of VAS among preschool children in Humbo district, Southern Ethiopia. Methods A cross-sectional study was conducted in April 2016. A total of 840 mothers/caregivers having children 6–59 months of age were selected using multistage cluster sampling technique from six rural villages implementing routine VAS program. Data were collected using interviewer administered questionnaire. Possible predictors considered in the study include distance from the nearby health facility, household socio-economic status, type of the household (model vs non-model), maternal access to health education on VAS, and knowledge on vitamin A and VAS. Multivariable logistic regression analysis was performed to identify predictors of uptake of VAS. The outputs are presented using adjusted odds ratio (AOR) with the respective 95% confidence interval (CI). Results The coverage of VAS was 75.0% (95% CI: 72.1–77.9). Better knowledge of mothers about the importance of the supplement (AOR: 1.49, 1.02–2.17), obtaining VAS related information from frontline community health workers (AOR: 1.51, 1.34–2.72) than health professionals and being from households in the “rich” wealth tertile (AOR: 1.80, 95% CI: 1.07–3.03) were positively associated with uptake VAS. Conclusion The VAS coverage of the area was approaching the expected national target of 80%. However, the uptake can be enhanced though awareness creation and improving socio-economic status of the community.

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Dietary Adequacy Among Young Children in India: Improvement or Stagnation? An Investigation From the National Family Health Survey

Food and Nutrition Bulletin ◽

10.1177/0379572119859212 ◽

2019 ◽

Vol 40 (4) ◽

pp. 471-487

Author(s):

Nizamuddin Khan ◽

Arupendra Mozumdar ◽

Supreet Kaur

Keyword(s):

Dietary Intake ◽

Health Survey ◽

Rural Areas ◽

Economic Status ◽

Family Health ◽

Northern Region ◽

Eastern Region ◽

National Family Health Survey ◽

The Past ◽

National Family

Background: This study assessed the trend of minimum acceptable dietary practices among children aged 6 to 23 months in India in the past decade. Methods: Data collected in the National Family Health Survey during 2005 to 2006 (NFHS-3) and 2015 to 2016 (NFHS-4) were used. The sample size for this study was 11 727 children for NFHS-3 and 61 158 children for NFHS-4. Bivariate and multivariate analyses were done to identify the predictors of feeding practices. We analyzed data of last-born singleton children aged 6 to 23 months who were living with their mother (ever-married women aged 15-49 years). Results: In India, a low proportion (10%) of children aged 6 to 23 months received a minimum acceptable diet, and its estimate remained the same in the past 10 years. Older mothers, educated mothers, antenatal care, high economic status, and place of residence were the most consistent predictors of minimum acceptable dietary intake. Over the past decade, however, the minimum acceptable dietary intake has declined among older children (odds ratio [OR] = 0.57, 95% confidence interval [CI], 0.47-0.70; P < .001), children with overweight mothers (OR = 0.40, 95% CI, 0.31-0·50; P <.001), and children of well-off families (OR = 0.29, 95% CI, 0.23-0.37; P < .001). The odds for minimum acceptable dietary intake were significantly higher among children of high (4+) birth order (OR = 1.74, 95% CI, 1.41-2.15; P < .001), rural areas, and children living in the central, eastern, and north-eastern region. Conclusion: Results indicate the need for further investigations of poor dietary intake among children living in well-off families and in the northern region. This study suggests policymakers and program managers to address contextual barriers against minimum acceptable dietary intake among children and to reconsider existing strategies in India.

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Uptake of routine vitamin A supplementation for children in Humbo district, Southern Ethiopia: Community-based cross-sectional study

10.21203/rs.3.rs-41145/v3 ◽

2020 ◽

Author(s):

Getnet Kassa ◽

Addisalem Mesfin ◽

Samson Gebremedhin

Keyword(s):

Preschool Children ◽

Vitamin A ◽

Vitamin A Deficiency ◽

Economic Status ◽

Cross Sectional Study ◽

Southern Ethiopia ◽

Sectional Study ◽

Cross Sectional ◽

Vitamin A Supplementation ◽

Socio Economic Status

Abstract Background: In low- and middle-income countries routine vitamin A supplementation (VAS) is a key strategy for reducing vitamin A deficiency and mortality and morbidity of preschool children. However, in Ethiopia, there is paucity of evidence regarding the level and determinants of the uptake of the supplement. This study was designed to assess the coverage and predictors of VAS among preschool children in Humbo district, Southern Ethiopia.Methods: A cross-sectional study was conducted in April 2016. A total of 840 mothers/caregivers having children 6-59 months of age were selected using multistage cluster sampling technique from six rural villages implementing routine VAS program. Data were collected using interviewer administered questionnaire. Possible predictors considered in the study include distance from the nearby health facility, household socio-economic status, type of the household (model vs non-model), maternal access to health education on VAS, and knowledge on vitamin A and VAS. Multivariable logistic regression analysis was performed to identify predictors of uptake of VAS. The outputs are presented using adjusted odds ratio (AOR) with the respective 95% confidence interval (CI). Results: The coverage of VAS was 75.0% (95% CI: 72.1-77.9). Better knowledge of mothers about the importance of the supplement (AOR: 1.49, 1.02-2.17), obtaining VAS related information from frontline community health workers (AOR: 1.51, 1.34-2.72) than health professionals and being from households in the “rich” wealth tertile (AOR: 1.80, 95% CI: 1.07-3.03) were positively associated with uptake VAS. Conclusion: The VAS coverage of the area was approaching the expected national target of 80%. However, the uptake can be enhanced though awareness creation and improving socio-economic status of the community.

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Prevalence and factors associated with triple burden of malnutrition among mother-child pairs in India: a study based on National Family Health Survey 2015–16

BMC Public Health ◽

10.1186/s12889-021-10411-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pradeep Kumar ◽

Shekhar Chauhan ◽

Ratna Patel ◽

Shobhit Srivastava ◽

Dhananjay W. Bansod

Keyword(s):

Public Health ◽

Health Survey ◽

Family Health ◽

Educational Status ◽

Binary Logistic Regression Analysis ◽

National Family Health Survey ◽

Wealth Status ◽

Cesarean Section Delivery ◽

Factors Associated ◽

National Family

Abstract Background Malnutrition in mothers as well as in children is a significant public health challenge in most of the developing countries. The triple burden of malnutrition is a relatively new issue on the horizon of health debate and is less explored among scholars widely. The present study examines the prevalence of the triple burden of malnutrition (TBM) and explored various factors associated with the TBM among mother-child pairs in India. Methods Data used in this study were drawn from the fourth round of the National Family Health Survey (NFHS-IV) conducted in 2015–16 (N = 168,784). Bivariate and binary logistic regression analysis was used to quantify the results. About 5.7% of mother-child pairs were suffering from TBM. Results Age of mother, educational status of the mother, cesarean section delivery, birth size of baby, wealth status of a household, and place of residence were the most important correlates for the triple burden of malnutrition among mother-child pairs in India. Further, it was noted that mothers with secondary education level (AOR: 1.15, CI 1.08–1.23) were having a higher probability of suffering from TBM, and interestingly the probability shattered down for mothers having a higher educational level (AOR: 0.90, CI 0.84–0.95). Additionally, mother-child pairs from rich wealth status (AOR: 1.93, CI 1.8–2.07) had a higher probability of suffering from TBM. Conclusion From the policy perspective, it is important to promote public health programs to create awareness about the harmful effects of sedentary lifestyles. At the same time, this study recommends an effective implementation of nutrition programs targeting undernutrition and anemia among children and obesity among women.

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Changing Scenario of Anemia Among Women in India: Understanding the Maternal Health Concern and Its Associated Predictors Through National Family Health Survey

10.21203/rs.3.rs-948470/v1 ◽

2021 ◽

Author(s):

Nivedita Roy ◽

Vijay Kumar Mishra ◽

Piyush Kumar Mishra ◽

Ashish Bandhu ◽

Rajeev Dhakad

Keyword(s):

Health Survey ◽

Economic Status ◽

Decomposition Analysis ◽

Family Health ◽

Health Concern ◽

National Family Health Survey ◽

Percentage Contribution ◽

Poor Households ◽

National Family ◽

Prevalence Of Anemia

Abstract Objectives: To study the changes in Anemia among women and to study the association between anemia and socio-demographic and economic predictors, also estimating the percentage contribution of selected predictors to Anemia among women belonging to poor and non-poor households.Methods: The State-wise percentages were taken from the extracted factsheets of National Family Health Survey 2015-2016 and 2019-2020. Absolute and relative percent changes to understand the changes in prevalence have been calculated. Multiple logistic regression was done to understand the associated varying predictors of Anemia among women. Percentage contribution of selected varying predictors through multivariate decomposition analysis have also been estimated. Results: Anemia prevalence was found the highest among the women in Goa and least in Lakshwadeep. The relative change in prevalence of Anemia was highest in Assam and lowest in Lakshwadeep. Socio-economic factors like marriage at a young age, lack of education, exposure to media, malnutrition, and poor economic status contribute significantly to the prevalence of Anemia among women of age 15-49 years.Conclusion: It is seen that the socio-demographic and economic burden on Anemia still continues to be higher than other medical predictors. The focus should be made more on education, malnutrition, and economic status to reduce the prevalence of Anemia.

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Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey

BMC Women s Health ◽

10.1186/s12905-021-01464-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jyotsna Negi ◽

Devaki Nambiar

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Marital Status ◽

Economic Status ◽

Family Health ◽

National Family Health Survey ◽

Place Of Residence ◽

Breast Examination ◽

National Family ◽

Summary Measures

Abstract Background Breast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women’s cancer in India. India’s National Family Health Survey (NFHS-4) data 2015–2016 shows that only 9.8% of women between the ages of 15 and 49 had ever undergone breast examination (BE). Further, access to screening and treatment is unequally distributed, with inequalities by socio-economic status. It is unclear, however, if socio-economic inequalities in breast examination are similar across population subgroups. Methods We compared BE coverage in population sub-groups categorised by place of residence, religion, caste/tribal groups, education levels, age, marital status, and employment status in their intersection with economic status in India. We analysed data for 699,686 women aged 15–49 using the NFHS-4 data set conducted during 2015–2016. Descriptive (mean, standard errors, and confidence intervals) of women undergoing BE disaggregated by dimensions of inequality (education, caste/tribal groups, religion, place of residence) and their intersections with wealth were computed with national weights using STATA 12. Chi-square tests were performed to assess the association between socio-demographic factors and breast screening. Additionally, the World Health Organisation’s Health Equity Assessment Toolkit Plus was used to compute summary measures of inequality: Slope index for inequality (SII) and Relative Concentration Indices (RCI) for each intersecting dimension. Results BE coverage was concentrated among wealthier groups regardless of other intersecting population subgroups. Wealth-related inequalities in BE coverage were most pronounced among Christians (SII; 20.6, 95% CI: 18.5–22.7), married (SII; 14.1, 95% CI: 13.8–14.4), employed (SII: 14.6, 95%CI: 13.9, 15.3), and rural women (SII; 10.8, 95% CI: 10.5–11.1). Overall, relative summary measures (RCI) were consistent with our absolute summary measures (SII). Conclusions Breast examination coverage in India is concentrated among wealthier populations across population groups defined by place of residence, religion, age, employment, and marital status. Apart from this national analysis, subnational analyses may also help identify strategies for programme rollout and ensure equity in women’s cancer screening.

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Does Socio-economic Inequality Exist in Micro-nutrients Deficiency among Children Aged 6-59 Months in India? Evidence from National Family Health Survey 2005-06 and 2015-16

10.21203/rs.3.rs-141687/v1 ◽

2021 ◽

Author(s):

Shobhit Srivast ◽

Shubham Kumar

Keyword(s):

Iron Deficiency ◽

Vitamin A ◽

Health Survey ◽

Vitamin A Deficiency ◽

Nutrient Deficiency ◽

Family Health ◽

National Family Health Survey ◽

Iron Supplement ◽

Action Group ◽

National Family

Abstract Background: The decadal change in Vitamin A and iron supplement deficiency changed at significant levels but still a matter of issue in India. The deficiency of Vitamin-A decreased from 81.9% to 40.5%, and iron supplement deficiency decreased form 95.3% to 73.9% from 2005-06 to 2015-16 among children aged 6-59 months in India. The present study determines the socio-economic inequalities in Vitamin A deficiency (VAD) and Iron deficiency (ID) among children aged 6-59 months in India and to estimate the change in the percent contribution of different socio-economic correlates for such inequality from 2005-06 to 2015-16.Methods: Data from National Family Health Survey (NFHS) 2005-06 and 2015-16 was used for the analysis. Bivariate analysis and logistic regression analysis was used to carve out the results. Moreover, Wagstaff decomposition analysis was used to carry out socio-economic inequality analysis.Results: It was revealed that Vitamin A deficiency was reduced from 85.5% to 42.1% whereas ID was reduced from 95.3% to 73.9% from 2005-06 to 2015-16 respectively. Child’s age, mother’s educational status, birth order, breastfeeding status, place of residence and empowered action group (EAG) status of states were the factors which were significantly associated with Vitamin A deficiency and Iron deficiency among children. Moreover, it was found Vitamin A deficiency and Iron deficiency got more concentrated among children from lower socio-economic strata. A major contribution for explaining the gap for socio-economic status (SES) related inequality was explained by mother’s education, household wealth status, empowered action group status of states for both Vitamin A deficiency and Iron deficiency among children under five years in India.Conclusion: Schemes like the Integrated Child Development Scheme (ICDS) would play a significant role in reducing SES related gap for micro-nutrient deficiency among children in India. Proper implementation of ICDS will be enough for reducing the gap between rich and poor children regarding micro-nutrient deficiency.

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Uptake of routine vitamin A supplementation for children in Humbo district, Southern Ethiopia: Community-based cross-sectional study

10.21203/rs.3.rs-41145/v2 ◽

2020 ◽

Author(s):

Getnet Kassa ◽

Addisalem Mesfin ◽

Samson Gebremedin

Keyword(s):

Preschool Children ◽

Vitamin A ◽

Vitamin A Deficiency ◽

Economic Status ◽

Cross Sectional Study ◽

Southern Ethiopia ◽

Sectional Study ◽

Cross Sectional ◽

Vitamin A Supplementation ◽

Socio Economic Status

Abstract BackgroundIn low- and middle-income countries routine vitamin A supplementation (VAS) is a key strategy for reducing vitamin A deficiency and mortality and morbidity of preschool children. However, in Ethiopia, there is paucity of evidence regarding the level and determinants of the uptake of the supplement. This study was designed to assess the coverage and predictors of VAS among preschool children in Humbo district, Southern Ethiopia.MethodsA cross-sectional study was conducted in April 2016. A total of 840 mothers/caregivers having children 6-59 months of age were selected using multistage cluster sampling technique from six rural villages implementing routine VAS program. Data were collected using interviewer administered questionnaire. Possible predictors considered in the study include distance from the nearby health facility, household socio-economic status, type of the household (model vs non-model), maternal access to health education on VAS, and knowledge on vitamin A and VAS. Multivariable logistic regression analysis was performed to identify predictors of uptake of VAS. The outputs are presented using adjusted odds ratio (AOR) with the respective 95% confidence interval (CI).ResultsThe coverage of VAS was 75.0% (95% CI: 72.1-77.9). Better knowledge of mothers about the importance of the supplement (AOR: 1.49, 1.02-2.17), obtaining VAS related information from frontline community health workers (AOR: 1.51, 1.34-2.72) than health professionals and being from households in the “rich” wealth tertile (AOR: 1.80, 95% CI: 1.07-3.03) were positively associated with uptake VAS.ConclusionThe VAS coverage of the area was approaching the expected national target of 80%. However, the uptake can be enhanced though awareness creation and improving socio-economic status of the community.

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